Background
Methods
Demographic features of cases
Sample collection
Detection of fetal chromosomal abnormalities
Whole genome sequencing (WGS) to detect fetal microdeletions/microduplications
Detection of variants in known genes related to congenital skeletal anomalies
Verification of gene mutations
Results
Clinical features of cases
No. | Ultrasound results | Gestation (weeks) | Chromosome | Micro-deletion/duplication results and significance |
---|---|---|---|---|
1 | Right choroid plexus cyst and left foot inversion in the fetus | 21 | Trisomy 18 | |
2 | Absence of radius in the upper limbs of the fetus, abnormal posture of both hands | 20 | Trisomy 18 | |
3 | Continuously interrupted left upper lip, broken upper alveolar bone, possible small jaw, and absent fetal femur | 25 | 46,XN | No abnormalities |
4 | Spinal fissure (isopathology), gastroschisis, double lung dysplasia, bipedal varus, left foot polydactyly | 25 | 46,XN | arr Xq26.2(133,527,188-133,533,879)×1 There is a 6.6 Kb deletion in the Xq26.2 segment of the fetal X chromosome. This fragment spans exon 4 and exon 5 of the PHF6 gene and does not correlate well with the patient’s clinical phenotype. |
5 | Bending bilateral femur, tibia and fibula, fixed knee, internal crossed flexion, and fixed foot position | 23 | 46,XN | No abnormalities |
6 | Cleft lip and palate, right kidney cystic dysplasia, bilateral foot fissure, and syndactyly, partially absent fingers of both hands | 25 | 46,XN | No abnormalities |
7 | Fetal bilateral femoral angulation deformity, fetal heart ventricular septal defect | 24 | 46,XN | 46,XN,dup(7q11.21)(64,635,655-64,947,696) × 3,46,XN,del(11p11.12)(49,009,009-49,120,197) × 1,46,XN,del(17p12)(14,099,119-15,464,828) × 1 No clear pathogenic >100Kb microdeletions/microreplications |
8 | Right foot inversion, bilateral rocker bottom feet, scoliosis, spina bifida occulta | 30 | 46,XN | No abnormalities |
9 | Fetal scoliosis, fetal bipedal varus, ventricular septal defect | 26 | 46,XN | No abnormalities |
10 | Absence of bilateral ulna and radius, absence of bilateral humerus, foot inversion, abnormal wrist joints | 24 | 46,XN | arr 2q24.3(166,914,464-166,920,459)×1 There is a 5.9Kb deletion in chromosome 2q24.3 on chromosome 2, which is not associated with a clinical phenotype. |
11 | Absence of bilateral humerus and left foot | 26 | 46,XN | No abnormalities |
12 | Only two visible metacarpal bones on the left hand and part of distal phalanx on the lateral and medial sides | 26 | 46,XN | No abnormalities |
13 | Left foot inversion, absence of right lower limb | 26 | 46,XN,21cenh+ | arr 5q35.1(170,405,440-171,071,061)×3 There is a repeat of 665 Kb fragment in the 5q35.1 segment of fetus chromosome 5, which includes 4 OMIM genes such as NPM1. The correlation with clinical phenotype is not high. |
14 | Absence of fetal fibula, foot inversion, partial absence of phalanges, absence of fingers, hand cleft deformity | 22 | 46,XN | No abnormalities |
15 | Fetal sirenomelia | 17 | 46,XN | No abnormalities |
16 | Short limbs - incomplete osteogenesis? | 23 | 46,XN | No abnormalities |
17 | Short limbs - incomplete osteogenesis | 22 | 46,XN | No abnormalities |
18 | Short limbs | 22 | 46,XN | No abnormalities |
19 | Short fetus limbs: cartilage hypoplasia? | 22 | 46,XN | No abnormalities |
20 | Short limbs, spine and vertebral ossification are not obvious: cartilage hypoplasia? | 16 | 46,XN | No abnormalities |
21 | Short limbs, ventricular septal defect | 15 | 46,XN | No abnormalities |
22 | Abnormal long bones in fetal limbs, narrow chest | 24 | 46,XN | No abnormalities |
23 | Short fetal limbs (chronic dysgenesis) | 25 | 46,XN | No abnormalities |
24 | Short limbs (cartilage hypoplasia) | 25 | 46,XN | arr 19p13.2(11,135,293-11,139,948)x, There is a deletion of 4.6 Kb fragment in the 19p13.2 segment of chromosome 19 of the fetus and there is no correlation with the patient’s clinical phenotype. |
25 | Short limbs | 21 | 46,XN | No abnormalities |
26 | Short limbs | 21 | 46,XN | No abnormalities |
27 | Short limbs | 27 | 46,XN | 46,XN,dup(2p11.2)(87,384,213-87,862,105) × 3, Polymorphism |
28 | Short limbs | 25 | 46,XN | No abnormalities |
29 | Achondroplasia | 15 | 46,XN | No abnormalities |
30 | Uneven arrangement of fetal spine, short limbs, bilateral foot inversion, small mandibular, left ventricular punctate strong echo, ventricular septal defect | 23 | 46,XN | Both chromosomes 1 and 16 have microduplications. Dup(Xq27.1)(139,911,843-140,072,771) × (2~3) Polymorphism |
Skeletal chromosomal abnormalities and microdeletions/microduplications
Sequencing and verification of hereditary bone disease in 13 cases of fetal local skeletal malformation
Detection of hereditary bone disease mutations using targeted gene sequencing and validation using sanger sequencing in 15 cases of systemic skeletal dysplasia (short extremities)
No. | Ultrasound results | Inheritance | Bone gene-encoded | Reference sequence | Nucleotide change/mutation | Amino-acid change | Genetic subregion | Heterogeneity | Chromosomal Loci | Mutation type | Sanger verification | Next pregnancy/child | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Paternal | Maternal | ||||||||||||
1 | Right choroid plexus cyst and left foot inversion in the fetus | Trisomy 18 | Delivered a healthy child | ||||||||||
2 | Absence of radius in the upper limbs of the fetus, abnormal posture of both hands | Trisomy 18 | Delivered a healthy child | ||||||||||
3 | Continuously interrupted left upper lip, broken upper alveolar bone, possible small jaw, and absent fetal femur | AD | TBX4 | NM_018488.2 | c.1200G > T | p.Glu400Asp | EX8E | Het | Chr17:59560439 | VUS | N | Het | |
4 | Spinal fissure (isopathology), gastroschisis, double lung dysplasia, bipedal varus, left foot polydactyly | AD | TNNT3 | NM_006757.3 | c.88G > A | p.Ala30Thr | EX7 | Het | Chr 11:1950355 | VUS | Het | N | Delivered a healthy child |
5 | Bending bilateral femur, tibia and fibula, fixed knee, internal crossed flexion, and fixed foot position | AD | SOX9 | NM_000346.3 | c.344G > C | p.Trp115Ser | EX1 | Het | Chr17:70117876 | VUS | N | N | Delivered a healthy child |
6 | Cleft lip and palate, right kidney cystic dysplasia, bilateral foot fissure, and syndactyly, partially absent fingers of both hands | AD | TP63 | NM_003722.4 | c.952C > T | p.Arg318Cys | EX7 | Het | Chr3:189585691 | Pathogenic | N | N | |
7 | Fetal bilateral femoral angulation deformity, fetal heart ventricular septal defect | AR | POR | NM_000941.2 | c.1370G > A | p.Arg457His | EX12 | Het | Chr7: 75614497 | Pathogenic | N | Het | Angular femoral deformity found at the 15th week of pregnancy, pregnancy terminated |
c.744C > G | p.Tyr248* | EX8 | Het | Chr7: 75611554 | Pathogenic | Het | N | ||||||
8 | Right foot inversion, bilateral rocker bottom feet, scoliosis, spina bifida occulta | AR | CHRNG | NM_005199 | C.13C > T | p.Q5X,513 | EX1 | Het | Chr2 | Pathogenic | N | Het | Same abnormality as the previous pregnancy, undergoing PGD |
C.202C > T | p.R68X,450 | EX3 | Het | Chr2 | Pathogenic | Het | N | ||||||
9 | Fetal scoliosis, fetal bipedal varus, ventricular septal defect | No abnormalities | |||||||||||
10 | Absence of bilateral ulna and radius, absence of bilateral humerus, foot inversion, abnormal wrist joints | No abnormalities | |||||||||||
11 | Absence of bilateral humerus and left foot | No abnormalities | |||||||||||
12 | Only two visible metacarpal bones on the left hand and part of distal phalanx on the lateral and medial sides | No abnormalities | |||||||||||
13 | Left foot inversion, absence of right lower limb | No abnormalities | |||||||||||
14 | Absence of fetal fibula, foot inversion, partial absence of phalanges, absence of fingers, hand cleft deformity | No abnormalities | Delivered a healthy child | ||||||||||
15 | Fetal sirenomelia | No abnormalities | Delivered a healthy child | ||||||||||
16 | Short limbs - incomplete osteogenesis? | AD | COL1A1 | NM_000088.3 | c.1678G > A | p.Gly560Ser | EX25 | Het | Chr17: 48268739 | Pathogenic | N | N | |
17 | Short limbs - incomplete osteogenesis | AD | COL1A2 | NM_000089.3 | c.1774G > A | p.Gly592Ser | EX31 | Het | Chr7: 94045726 | Pathogenic | N | N | |
18 | Short limbs | AD | COL1A2 | NM_000089.3 | c.1072G > A | p.Gly358Ser | EX20 | Het | Chr7: 94039590 | Pathogenic | N | N | Delivered a healthy child |
19 | Short fetus limbs: cartilage hypoplasia? | AD | COL2A1 | NM_001844.4 | c.3013G > A | p.Gly1005Ser | CDS44 | Het | Chr12:48371891 | Pathogenic | N | N | |
20 | Short limbs, spine and vertebral ossification are not obvious: cartilage hypoplasia? | AD | COL2A1 | NM_001844.4 | c.2419G > A | p.Gly807Arg | EX37 | Het | Chr12:48375170 | VUS | N | N | |
21 | Short limbs, ventricular septal defect | AD/ AR | COL11A2 | NM_080680.2 | c.966dupC | p.Thr323Hisfis*19 | EX8 | Het | Chr6:33152074 | Pathogenic | Het | N | Undergoing PGD |
c.1773 + 8 T>A | – | IVS19 | Het | Chr6:33146204 | VUS | N | Het | ||||||
22 | Abnormal long bones in fetal limbs, narrow chest | XD | EBP | NM_006579.2 | c.440G>A | p.Arg147His | EX4 | Het | ChrX:48385644 | Pathogenic | N | N | Delivered a healthy boy |
23 | Short fetal limbs (chronic dysgenesis) | AD | FGFR3 | NM_001163213.1 | c.742C > T | p.Arg248Cys | EX7 | Het | Chr4:1803564 | Pathogenic | N | N | Delivered a healthy child |
24 | Short limbs (cartilage hypoplasia) | AD | FGFR3 | NM_001163213.1 | c.742C > T | p.Arg248Cys | EX7 | Het | Chr4:1803564 | Pathogenic | N | N | |
25 | Short limbs | AD | FGFR3 | NM_001163213.1 | c.742C > T | p.Arg248Cys | EX7 | Het | Chr4:1803564 | Pathogenic | N | N | |
26 | Short limbs | AD | FGFR3 | NM_001163213.1 | c.742C > T | p.Arg248Cys | EX7 | Het | Chr4:1803564 | Pathogenic | N | N | |
27 | Short limbs | AD | FGFR3 | NM_001163213.1 | c.1144G > A | p.Gly382Arg | EX9 | Het | Chr4:1806119 | Pathogenic | N | N | |
28 | Short limbs | AD | FGFR3 | NM_001163213.1 | c.1124A > G | p.Tyr375Cys | EX9 | Het | Chr4:1806099 | Pathogenic | N | N | |
29 | Achondroplasia | AD | FGFR3 | NM_001163213.1 | c.2426G > C | p.X809S,101 | EX18 | Het | Chr4:1806099 | Pathogenic | N | N | |
30 | Uneven arrangement of fetal spine, short limbs, bilateral foot inversion, small mandibular, left ventricular punctate strong echo, ventricular septal defect | AD | FLNB | NM_001164317.1 | c.475A > C | p.Thr159Pro | EX2 | Het | Chr3:58062955 | VUS | N | N |